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Mohamed AlyPasha
1769-1849
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“ The Burden of Dementia
in an Extended FamilySocial Network - a
Historical Perspective
Nasser Loza & Waleed Fawzi
Istanbul October 2005
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• Religious & moral culture
• Belief in life after death
• Historical records
• Migration and wars
The Middle East
General considerations
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Ramses ll
Died 96 years old
Reigned 65 years
200 wives, 156 children,
(96 sons 60 daughters)
Ramses ll
Died 96 years old
Reigned 65 years
200 wives, 156 children,
(96 sons 60 daughters)
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Pharaonic civilisation
Djedi, a magician is congratulated bythe pharaoh's son on reaching theage of 110 years :
“Your condition is like that of a manwho has not yet reached old age…
who sleeps until the morning, who isimmune from illness, without theslightest cough…”
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Judaism
“Show you fear from God by standing
up in the presence of elderly people
and showing respect for the aged. I
am the LORD.”
Leviticus 19:32
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Islamic Civilisation
Ibn Masud said, “I asked the Messenger
of Allah (pbuh) which deed is the most
beloved to Allah?” He said: “The prayer
at its proper time.” I said: “What next?”
He said: “Filial piety to the parents.” I
said: “What next?” He said: “The Holy
Jihad for Allah’s sake.”(Al-Bukhari,Muslim)
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Islamic Civilisation
Abdullah bin Amr bin Al Aas related that
the Messenger (pbuh) said: “Major sins are:
To worship a partner with Allah, to disobey
the parents, to kill the soul and to take a
false oath.”(Al-Bukhari)
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Overview
• Traditional structure of ME families
• Factors causing transition
• Care needs for dementia sufferers• Patterns of provision of care
il
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Family Structure The elderly population in
Egypt
3.242
4.462
6.557
9.814
14.103
0
20
40
60
80
100
120
140
millions
1990 2000 2010 2020 2030
60+
Total
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Family Structure
• Number of children (Contraception)
• Extended
• Polygamy• Daughters in law
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Who Cares?
• Community sample of 461 elderly Egyptiansapproached in street interviews and OP clinics. WHOstudy ( Sadek et al 2002)
0%
5%
10%
15%
20%
25%
30%
35%
Living Arrangements
Alone
Spouse only
Spouse & marriedchildren
Married children
Unmarried children
Relatives
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Female role
• Education
• Employment
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Factors causing transition
• Increased longevity
• A shift towards nuclear family
• Migration
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Factors causing transitionEgyptians > 60 years
0
2
4
6
8
10
12
14
16
millions
1990 2000 2010 2020 2030
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Factors causing transitionEgyptians > 80 years
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
millions
2000 2010 2020 2030
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Factors causing transitionMigration
External Migration
– Middle East
– West
F t i t iti
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Factors causing transitionRural to Urban population in
Egypt1950
57%
43%
% rural
% Urban
2000
44%
56%
2025
29%
71%
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Factors causing transitionMigration
Rural to urban distribution in 1986:
56.1 / 43.9 vs 59 / 41 for
the elderly
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Systems of care
• Care in the community
• Day Centres and Day Hospitals
• Residential Homes• Nursing Homes
• Care for Dementia patients with
behavioural disturbances
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Care needs for dementiasufferers
• Assistance with activities of dailyliving
• Social and psychological support
• Economic factors
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Homes for the elderly in Egypt(2000)
• Cairo: 36 accommodating 1980 residents
• Giza 5 accommodating 183 residents
• Alexandria 13 accommodating 994 residents
• Rest of the country 27 accommodating 700 residents
• Total Beds for healthy elderly in Egypt 3857 residents
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• Leaving 4 458 882 estimated elderlycared for in the community in 2000
• Leaving 14 099 743 estimated elderlycared for in the community in 2030
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Caregiver Burden forDementia
Study on 40 carers (1999) showsFemales are the primary caretakersMost frequent problems are
Exhaustion due to increased patients’ requirements Insufficient time to care for children Late for work Decreased social interactions with family and friends Fear of inheriting the disorder
Increased financial burden
Hassan M, (1999). Assessment of Psychological stress facing familycaregivers of elderly patients with dementia, (M. Sc. Thesis).
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Caregiver burden in EgyptAbido AM, Ashour AM, Assad T, El Nahas G. (2000). Stress of geriatric patient caregivers, M.Sc. Thesis
• 30 psychiatric outpatients with care giving relatedproblems in Cairo (Matareya Hospital)
• Assessed using – Psychiatric and medical history for patients
– Assessment of financial situation – The burden Interview (Zarit, 1985)
• 5 cases suffering from dementia with behaviouralsymptoms
• 5 cases assessed qualitatively for medical socialpsychological and economical stresses and followedup after provision of support
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FindingsAbido et al. 2000
• 1 carer in 70% of cases
• 2 carers or more 30%
• 43% working full time and 57%housewives
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Findings Abido et al. 2000
Patient related factors increasingcaregiver stress
• Behavioural symptoms in dementia
• ADL abilities
• Sleep disturbance
• Incontinence
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FindingsAbido et al. 2000
Carer related factors
• Gender
• Occupation• Economic status
• Support from other family members
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Findings Abido et al. 2000
• Carers received very limited supportin the community and provisionCouncelling and education regarding
coping techniques reduced caregiverburden substantially
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Discussion
Building on local traditions and values
Vs.
Adapting international approaches tocaring for the elderly
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Discussion
Implications for services & research:
• Adopting local practices
• Translation & Validation of international questionnaires
• Developing local tools